OrganizationActiveAccepts Medicare
Redwood Pediatric Medical Group
NPI 1164574083 · Specialist · Fortuna, CA
Enrolled with Medicare as Part a Provider - Rural Health Clinic · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1164574083
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Shalamar Ivey, Billing Manager(707) 725-9355
- License
- G082256 (CA)
Specialties & taxonomies
Other Service Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3305 Renner Dr
Fortuna, CA 95540-3119
Phone: (707) 725-9355
Fax: (707) 725-2426
Street-level locationGet directions
Mailing address
3305 Renner Dr
Fortuna, CA 95540-3119
Registry dates
- Enumerated
- 2007-01-18
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.